Hospital - Insurance Contracting Part 1: Case Rates and Per Diems Explained

Hospital - Insurance Contracting: Case Rates and Per Diems Explained.
In this video you will learn how hospital prices are negotiated between hospital systems and health insurance carriers.
There are multiple contractual strategies and this video in particular covers the following methodologies:
--Case Rates
--Per Diems
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[@MeherScholar]

Dr. Bricker, would you please do another video with regard to case rates. The Journal of Urgent Care Medicine reports that more urgent care clinics are going to case rates, and indeed I was hit with a $608.00 allowed amount for getting a flu test at a hospital-owned urgent care. Similarly, a KZbin video titled "15-minute procedure to remove earwax results in $1,800 bill," explains that the patient got this bill because the provider had a case rate negotiated with insurance. My biggest concern is that neither the provider nor insurer in my experience revealed the case rate in advance, skirting price transparency regulations. Can they legally avoid pricing transparency laws by using case rates? I hope you can shed light on this!

[@ahealthcarez]

Thank you for watching and for your suggestion.

[@thabitpulak]

As a 4th year medical student who is about start residency, but also has a strong interest in hospital/healthcare economics, I very much appreciate your dive into the specific details Dr. Bricker!

[@ahealthcarez]

Super. Thank you for watching.